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MEASLES UPDATE (49): ASIA, EUROPE, PACIFIC
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A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
Asia
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[1] Pakistan

Europe
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[2] Ukraine (Ternopil)
[3] France

Pacific
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[4] Australia

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[1] Pakistan
Date: Wed 4 Oct 2017
Source: Pakistan Observer [edited]
http://pakobserver.net/7-kids-suffer-measles-outbreak/


At least 7 cases of measles have been reported in far-flung mountainous areas Lagharai Bayanzai and Zharbazhai Sherani - lacking health facilities.

The area people alleged that the entire focus of the government and Health department was on the anti-polio campaign, while no measures were being taken to prevent other viral diseases. "The poor quality and ailing routine vaccination program are the factors in the surge of measles cases. The recent cases indicate that the measles surveillance system is not up to the mark", said an official who wished not be named. Meanwhile, District Health Officer Dr. Arif Shah has told reporters that medical teams have been dispatched to the affected areas on emergency basis and all necessary measures would take place to cope with the situation and immunize the children.

[Byline: Rafiullah Mandokhail]

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Communicated by:
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[A Healthmap/Promed map of Pakistan can be found at http://healthmap.org/promed/p/140]

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Europe
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[2] Ukraine (Ternopil)
Date: Wed 4 Oct 2017
Source: The Quebec Times [edited]
https://theqtimes.com/in-ternopil-announced-the-measles-outbreak/22593


In Ternopil announced the measles outbreak and to stop the spread of infection, [by] [Tue 10 Oct2017], children who have not received any vaccination against measles will not be accepted in kindergartens and schools, told the City Council.

The city has recorded 5 cases, according to the Ternopil oblast laboratory center MOH Ukraine.

"A measles outbreak is declared when [after] 3 cases of measles. As of today [Wed 4 Oct 2017], the city recorded 5 such cases," - said the Deputy head of the Health Department of Ternopil City Council, Olga Yarmolenko.

Now in Ternopil [1134 children have not been vaccinated, and 8663 children have not followed the proper schedule of vaccination], as presented in the City Council.

According to Ms. Yarmolenko, those who did not receive the vaccine may do so in the near future: "The measles vaccine in the city is free of charge and in sufficient quantity," she said.

Earlier it was reported that in Kiev, for 6 months, 11 cases of measles were registered.

--
Communicated by:
ProMED-mail from HealthMap Alerts
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[A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/123]

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[3] France
Date: Thu 5 Oct 2017
Source: The Stopru [edited]
https://stopru.org/measles-measles-is-already-405-cases-from-january-2017/21697


From 1 Jan -- 31 Jul 2017, 405 cases of measles have been reported in France, announced in a press release the Public Health agency of France, who alert: "France is not immune to a [significant] new outbreak of measles ". As a point of comparison, year-on-year, in 2016, 79 cases "only" were reported.

Measles is a highly contagious viral disease. It is transmitted by air and contact-free and in some cases can cause respiratory disorders or serious neurological [problems]. It is one of the leading causes of death among young children in the world.

In 2017 in France, the highest incidence rate was observed in children less than one year (6.3/100 000), not targeted by vaccination who may be protected only if people around them are immunized against the disease. "This is very worrying, because the complications (neurological or pulmonary) are more common and severe in this age group as well as among young adults," says Public Health France. However, the disease has touched in 2017 all age groups: patients between one month and 75 years of age (the median age is 13 years). Up to 41 percent of patients had to be hospitalized for encephalitis or severe pneumonitis. A young woman of 16-years-old, without medical history and not vaccinated, died, "in an array of acute respiratory distress and multiple organ failure", the agency says.

A peak of the epidemic of measles was registered in May 2017, with 114 reported cases. No region is spared [see map at URL above]. "No department is reaching the 95 percent vaccination coverage at 2 years for the 2 doses of the vaccine, the rate required to enable the elimination of the disease," explains Public Health France. The precarious populations that frequent the shelters and communities, [who are not vaccinated] such as travellers, are especially at risk.

From 2008 -- 2016, over 24 000 cases of measles have been reported in France, where nearly 15 000 cases [were reported] in 2011 alone [see graph at URL above]. Ten patients died. Nearly 1500 cases have presented a serious pneumopathy, 34, a neurological complication. The number of cases sharply decreased in 2012, and then remained stable in 2013 and 2014 (respectively, 859, 259 and 267 reported cases). In 2015, the number of cases increased again (364 cases), in connection with a major outbreak in Alsace.

According to the immunization schedule in force, it is recommended to any person who is at least 12 months and born after 1980, 2 doses of trivalent vaccine (measles-mumps-rubella). For the time, 3 vaccines together in the DT-Polio (diphtheria, tetanus and polio) are mandatory and 8 others, against measles and hepatitis B in particular, are recommended. Children born from 1 Jan 2018 must be vaccinated against 11 diseases.

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[A Healthmap/ProMED map of France can be found at http://healthmap.org/promed/p/100]

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Pacific
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[4] Australia
Date: Thu 5 Oct 2017
Source: Dockland news [edited]
http://www.docklandsnews.com.au/editions/article/collins-square-measles-outbreak_13503/


On [Sun 1 Oct 2017], Victorian health authorities announced 11 cases of measles, with 8 of them linked to Collins Square in Docklands.

Victoria's chief health officer Prof Charles Guest advised people who work in or around Collins Square to be aware of the signs and symptoms of the disease.

Prof Guest said measles had an incubation period of 7 -- 18 days, so anyone who visited Collins Square might not develop symptoms until mid-October.

Measles is a highly infectious viral disease that can cause serious illness, particularly in very young children and adults. People can develop pneumonia and other serious complications from the disease, and often need to be hospitalised.

The illness usually begins with common cold symptoms such as runny nose, red eyes and a cough, followed by fever and rash, Prof Guest said.

"The characteristic measles rash usually begins 3 to 7 days after the 1st symptoms, generally starting on the face and then spreading to the rest of the body," he said.

"Anyone developing symptoms is advised to ring ahead to their GP or hospital 1st and tell them that they have fever and a rash so that appropriate steps can be taken to avoid contact with other patients."

The disease is now uncommon in Australia because of the widespread use of the measles vaccine. It is important to immunise children because of the risk from overseas travellers.

Prof Guest said most cases of measles in Victoria were linked to international travel, with the disease more prevalent in many countries overseas.

The measles vaccine is currently recommended on the National Immunisation Program at 12 months and again at 18 months. Immunisation is the best protection against measles.

Anyone who is unvaccinated is at risk of contracting measles. Adults aged between 26 and 52 have a lower immunisation coverage than younger adults and children and therefore most cases are in this age group. Most people over the age of 52 will have been exposed to measles in childhood, and therefore will be protected.

--
Communicated by:
ProMED-mail from HealthMap Alerts
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[A Healthmap/Promed map of Australia can be found at http://healthmap.org/promed/p/186]

[These outbreaks are caused by vaccine coverage that is below the 95 percent necessary to protect the population who cannot be vaccinated, or who are too young to be vaccinated. Death following measles infection should not occur when there is an efficacious vaccine available.

Australia and a number of countries in Europe are experimenting with punitive measures where parents may face fines if they fail to give their kids the recommended shots. In Australia, the directors of schools that let the unvaccinated kids in would be fined too.

This marks a pretty aggressive shift in how we manage vaccine refusers and the costly, deadly outbreaks of diseases like measles and whooping cough they help spark.

Here's a quick roundup of the global crackdown on vaccine-refusing parents:

Italy's parliament passed a law this summer that makes 10 childhood vaccinations mandatory for kids up to age 16, and requires parents to prove their children are immunized before entering school or else face a 500 euro (about USD 600) noncompliance fine.

Germany is also cracking down on vaccine-refusing parents: Its parliament approved a law that obliges administrators at kindergartens to report parents who refuse counseling from their doctors about vaccines. Health ministries can then also fine the vaccine-hesitant parents up to 2500 euro (about USD 3000).

In France, the health ministry is making 11 vaccines -- up from the current 3 (diphtheria, tetanus, and polio) -- mandatory for children by 2018, though there's no talk of a fine there yet.

In Romania, the government recently adopted a draft bill that requires parents prove their children are vaccinated before kids can go to school.

New South Wales Australia passed "no jab, no play" legislation in September: Effective January, the law bans unvaccinated kids from preschool and day care and fine the directors of schools that admit un-immunized children 5500 Australian dollars (USD 4400). The law in South Australia is modeled on similarly stringent laws in other Australian states, and across the country, parents with children who aren't immunized aren't eligible for child care benefits.

Europe has long struggled with a vaccine mistrust problem, and these new laws and policy proposals arose in the context of ongoing, unprecedented measles outbreaks across the continent. Italy has recorded more than 4400 measles cases this year [2017] and 3 deaths -- including one in a child whose immune system was compromised because of chemotherapy for cancer. Romania, meanwhile, has been battling Europe's deadliest measles outbreak, with more than 8000 cases and 32 deaths since January [2017].

Australia has also dealt with its share of vaccine-preventable disease outbreaks, and the government crackdown is part of a push to get 95 percent of Australian children vaccinated with routine immunizations, above the current rate of 93 percent.

The anti-vaccine landscape in America isn't all that different. Here, vaccine skeptics have also been persuading more parents in a number of states to refuse shots for their children. So is the US ready for a similar crackdown?

"I think we're not there in the US, unless there is an outbreak of a serious epidemic requiring a public health emergency," said Baylor College infectious disease researcher Peter Hotez.

Punishing parents for doing things that could harm their kids is not without precedent in the US, either. For example, there are laws in various states requiring parents to use car seats or seat belts for their children or else pay a fine or be docked driver's license points. Same goes for firearm storage laws.

But before we start fining anti-vaxxers, there are some much more basic steps the US could take that would improve vaccination rates. And they involve simply making it harder for parents to opt out of routine shots on behalf of their kids. California offers an instructive example of what that could look like for the rest of America.

The US is currently a patchwork of vaccine laws, and states with tougher laws have lower rates of vaccine refusals. Vaccines fall under the public health jurisdiction of the states. And there's currently a lot of variation across the US when it comes to immunization requirements.

All 50 states currently have legislation requiring vaccines for students -- but almost every state allows exemptions for people with religious beliefs against immunizations, and 18 states grant philosophical exemptions for those opposed to vaccines because of personal or moral beliefs. (The exceptions are Mississippi, California, and West Virginia, which have the strictest vaccine laws in the nation, allowing no philosophical or religious exemptions.)

"States expect that in order to access public resources, like schools, camps, or child care centers, individuals must give up some autonomy to make sure everyone in the community is safe," said University of Colorado Denver sociologist Jennifer Reich, who studies the anti-vaccine movement.

Perhaps unsurprisingly, the parts of the country that make it easier for people to opt out of their shots tend to have higher rates of ... people opting out of vaccines. So a lax regulatory environment can create space for more parents to refuse vaccines. California has made it tougher to opt out of vaccines -- with great results. Some states have been moving to crack down on this trend -- most notably California -- and they're already seeing success in terms of boosting vaccine coverage rates.

California Gov. Jerry Brown signed a controversial bill in 2015 that required almost all schoolchildren in the state to be vaccinated, unless they have a medical reason for opting out. The law, SB277, was a response to a large measles outbreak that originated at the Disneyland theme park, and it means parents can no longer refuse to vaccinate their children for religious or philosophical reasons.

Early data from the California state health department suggest the law appears to have an impact -- even before it went into effect. For the 2015-16 school year, 93 percent of kids received all of the required vaccinations, up from 90 percent in 2014 and 2013.

Immunization rates in Mississippi and West Virginia -- the other 2 US states with strict opt-out policies -- suggest there are real public health benefits to making it harder for parents to refuse vaccines. In the 2014-15 school year, more than 99 percent of kindergartners in Mississippi had their measles-mumps-rubella and diphtheria-tetanus-pertussis shots -- the highest rate in the US. The rates for those vaccines were 98 percent for kindergartners in West Virginia. These figures are much higher than the national averages (85 percent for diphtheria-tetanus-pertussis and 92 percent for the measles-mumps-rubella vaccines).

So there's a lot of room for improvement at the state level to toughen up vaccine requirements, even before the US starts considering fines.

"It's looking like in California, simply closing nonmedical exemptions is having a desired effect in terms of boosting vaccine coverage in public schools," Hotez said. "Based on that evidence, I think that needs to be the focus -- closing nonmedical exemptions in the 18 states that still allow it."

[Excerpted from Vox, https://www.vox.com/science-and-health/2017/8/3/16069204/vaccine-fines-measles-outbreaks-europe-australia] - Mod.LK]

See Also

Measles update (48): Europe, Asia, South America, Africa, Pacific 20171003.5358796
Measles update (47): Americas, Europe, Asia, Africa 20170928.5345823
Measles update (46): Africa, Europe, Pacific, South America 20170924.5337792
Measles update (45): Africa, Europe, South Pacific 20170919.5327258
Measles update (44): Africa, Europe, South America, Indian Ocean http://promedmail.org/post/ 20170908.5304434
Measles update (43): Asia and Pacific, Europe, demographics http://promedmail.org/post/ 20170827.5277324
Measles update (42): Europe, Middle East, Africa, Pacific http://promedmail.org/post/ 20170821.5263535
Measles update (41): Europe (Finland, Italy) http://promedmail.org/post/ 20170817.5256860
Measles update (40): Africa, Europe http://promedmail.org/post/ 20170812.5244541
Measles update (39): Europe, South Africa http://promedmail.org/post/ 20170806.5230541
Measles update (38): Europe, Asia http://promedmail.org/post/ 20170729.5214459
Measles update (37): Bangladesh (CG) fatal, children http://promedmail.org/post/ 20170718.5185991
Measles update (36): USA, Europe (Wales, Northern Ireland), Pacific (Indonesia) http://promedmail.org/post/ 20170716.5179734
Measles update (35): Europe, USA http://promedmail.org/post/ 20170712.5170151
Measles update (34): Europe, Africa, USA http://promedmail.org/post/ 20170702.5145654
Measles update (33): USA, Europe, Africa http://promedmail.org/post/ 20170622.5122286
Measles update (32): Africa, Europe, Asia, USA http://promedmail.org/post/ 20170615.5106403
Measles update (31) http://promedmail.org/post/ 20170606.5087889
Measles update (30) http://promedmail.org/post/ 20170603.5080696
Measles update (29) http://promedmail.org/post/ 20170527.5065373
Measles update (28) http://promedmail.org/post/ 20170523.5055301
Measles update (27) http://promedmail.org/post/ 20170516.5039511
Measles update (26) http://promedmail.org/post/ 20170512.5030092
Measles update (25) http://promedmail.org/post/ 20170507.5019551
Measles update (24) http://promedmail.org/post/ 20170430.5004210
Measles update (23) http://promedmail.org/post/ 20170426.4995241
Measles update (22) http://promedmail.org/post/ 20170421.4986467
Measles update (21) http://promedmail.org/post/ 20170419.4979444
Measles update (20) http://promedmail.org/post/ 20170415.4972251
Measles update (19) http://promedmail.org/post/ 20170413.4967610
Measles update (18) http://promedmail.org/post/ 20170408.4956873
Measles update (17) http://promedmail.org/post/ 20170405.4948384
Measles update (16) http://promedmail.org/post/ 20170401.4941388
Measles update (15) http://promedmail.org/post/ 20170329.4934570
Measles update (14) http://promedmail.org/post/ 20170325.4924756
Measles update (13) http://promedmail.org/post/ 20170319.4910476
Measles update (12) http://promedmail.org/post/ 20170314.4900920
Measles update (11) http://promedmail.org/post/ 20170309.4888914
Measles update (10) http://promedmail.org/post/ 20170303.4874401
Measles update (09) http://promedmail.org/post/ 20170221.4855486
Measles update (08) http://promedmail.org/post/ 20170215.4842312
Measles update (07) http://promedmail.org/post/ 20170209.4827912
Measles update (06) http://promedmail.org/post/ 20170201.4808554
Measles update (05): India (BN) New Zealand ex Singapore, USA (NJ) http://promedmail.org/post/ 20170129.4801137
Measles update (04): Australia (VI, NS), USA (CA), Netherlands http://promedmail.org/post/ 20170123.4784372
Measles update (03): Pakistan (BA), Australia (NS), Switzerland http://promedmail.org/post/ 20170112.4761857
Measles update (02): Australia (NS), Romania (TM), USA (CA) http://promedmail.org/post/ 20170106.4747028
Measles update (01): USA (CA), Sudan (SK) http://promedmail.org/post/ 20170103.4740174
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